At a time when corridor care is rarely out of the headlines, social care is in crisis and the assisted dying debate continues to divide opinion, Madeleine Anderson sits down with Paulette Hamilton, Labour MP, health and social care committee member, and former district nurse to discuss the challenges of nursing in 2025.
‘Frontline nurses don’t see enough of frontline politicians’
Having entered politics after leaving her district nursing career, Birmingham Erdington Ms Hamilton has used her community care background to shape her role as a parliamentarian.
Looking back on her years in nursing, she says many people still do not understand what district nurses do, and therefore often overlook the challenges that can come with the role.
‘It can be very hard to explain to people how lonely it can be. But it can also be very exciting if you manage to get the care for someone sorted. It doesn’t always happen, but it’s very happy when it does,’ she says.
‘Nurses that are in the community and in primary care unfortunately are treated like second class citizens, and I think there needs to be some work to change perceptions.
‘They are just as valuable as nurses in hospitals, because the work they do is what keeps people out of the hospital and in their own home.’
Ms Hamilton, who became a Labour MP in 2022 having previously worked as a local councillor, says more attention should be given to the ‘value’ of district nurses – including through more training opportunities and exposure to community and social care nursing for nursing students.
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‘We need to look at the role and we need to value them. In order to do that people need to understand what the role is,’ she adds.
Ms Hamilton acknowledges that ‘frontline nurses don’t see enough of frontline politicians’, but added that the scale of the nursing workforce would make it challenging for professionals to engage with politicians day to day.
Her comments come after health and social care secretary, Wes Streeting, last month told the Health and Social Care Committee that district nurses are often ‘undervalued and understaffed’ – a message Ms Hamilton stood by during our interview.
‘Palliative care needs a complete overhaul’
Ms Hamilton has spoken against the Terminally Ill Adults (End of Life) Bill in recent months, having warned that the bill cannot be ‘implemented ethically and safely’ when voting against it in November last year.
The bill, which has passed its second reading, would allow adults in the last six months of their life to be medically assisted to die in England and Wales. In its current form it has various safeguards for those who want to seek assistance to end their own life – including that patients must be 18 and a resident of England or Wales with mental capacity to make the choice on assisted dying. It still has several steps to go through before any potential changes to the law would come into force.
Sharing her concerns with Nursing in Practice, Ms Hamilton says palliative care services are ‘too patchy’ to offer patients a genuine choice and would risk putting unfair and inappropriate pressure on nurses involved in care related to assisted dying.
‘Palliative care needs a complete overhaul. Where you live impacts the standard of palliative care you can access, or even the opportunity for good palliative care, because it’s very hit or miss how palliative care is offered,’ she explains.
Patient’s need the reassurance that they are not going to have a ‘painful, long, withdrawn death’, and that they are going to receive ‘the care that they need’, in order to make an informed decision on assisted dying, she adds.
‘Because I’ve been a practitioner, and because I’m now a parliamentarian, I think until we’ve sorted out a lot of the difficulties in the health service, you cannot tell someone you’re giving them a choice,’ Ms Hamilton says.
Last month, Professor Nicola Ranger, general secretary and chief executive of the Royal College of Nursing (RCN), told the Health and Social Care Select Committee that nurses must be included in any education and training that would be created if assisted dying legislation was introduced into the UK.
Ms Hamilton agrees workforce support must be kept in line with any changes in legislation.
‘You need support both psychologically, as well as the training to know what to say to [patients],’ she says.
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‘You need to know how to understand [the legislation].’
At the start of the year, the Health and Social Care Committee and its expert panel asked the government to set out its ‘expectations’ for the ‘level and standard’ of palliative care that should be provided in England. It comes as part of an independent evaluation of palliative care services which is expected to launch.
Hospice funding
Ms Hamilton put her concerns about palliative care in the context of an underfunded and overstretched hospice sector.
Following an increase in National Insurance contributions (NICs) from 13.8% to 15% in the October budget, the government last month announced a new capital grant funding package to help hospices to improve their buildings, equipment and accommodation.
While recognising this, Ms Hamilton also warns that the capital funding ‘will run out,’ and says she wants to see a wider overhaul of hospice funding.
‘There has to be a mechanism in place where funding is put in place [so] that year in, year out, they are funded. And the money you get through charities is an additional sector funding, not the core funding’, she explains.
When the news of the National Insurance hikes broke last year, industry leaders warned hospices will face ‘tough decisions’ and could be forced to cut back nursing services.
Corridor care
The ongoing hospital corridor care crisis was also flagged by Ms Hamilton.
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Ms Hamilton says a major ‘blockage’ in the social care system must be addressed to fix the growing crisis of corridor care but that efforts to ‘drive that change’ were yet to be introduced.
Last week, the RCN made an appeal for greater investment in primary, community and social care nursing to help resolve the corridor care crisis.
This came after a YouGov poll showed half of the public say it should take the government no more than a year to fix the issue of corridor care.
